For BOI Office Use Only
ATN#__________________________
SID#_______________________
TIME F/P COMPLETED__________
TIME DESC.COMP______________
FEES
$10.00 Fingerprint Fee (if printed at LSP Headquarters)
$26.00 Processing Fee (required whether printed at LSP
Headquarters or when mailing in two fingerprint cards)
Louisiana State Police
Bureau of Criminal Identification and Information
P.O. Box 66614 - Box A-6
Baton Rouge, LA 70806
When submitting fingerprints:
In person: two separate money orders, cashier checks, business checks for $10 and $26 or a credit card
By mail: include two FBI (form FD-258) fingerprint cards and a $26 money order, cashier check or business check
RIGHT TO REVIEW
**Electronically submitted fingerprints obtained at LSP Headquarters after
3:30 will be available for pickup the next business day.
****PLEASE TYPE or PRINT****
APPLICANTS FULL NAME:
LAST
FIRST MIDDLE
STREET ADDRESS:
COMPLETE STREET ADDRESS TO INCLUDE APARTMENT/LOT #
CITY:
STATE: ZIP CODE:
PHONE NUMBER:
SOCIAL SECURITY NUMBER: DATE OF BIRTH:
DRIVERS LICENSE OR ID NUMBER: STATE OF ISSUE:
RACE: SEX:
APPLICANTS SIGNATURE:
AUTHORIZATION TO DISCLOSE CRIMINAL HISTORY RECORDS INFORMATION
By my signature above, I hereby authorize the Louisiana State Police to release all pertinent criminal record information maintained in their
files, other states files, or the FBI files (if applicable ) which may confirm or deny my eligibility with the facility or agency named above.
Pursuant to Title 28, C.F.R. Section 16.34, officials making the determination of suitability for licensing or employment shall provide the opportunity to
complete, or challenge the accuracy of, the information contained in the state or FBI identification record.
Revised 1/8/2018
